Iron Poisoning

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Milton Tenenbein - One of the best experts on this subject based on the ideXlab platform.

  • unit dose packaging of Iron supplements and reduction of Iron Poisoning in young children
    JAMA Pediatrics, 2005
    Co-Authors: Milton Tenenbein
    Abstract:

    Background Iron Poisoning is a major cause of unintentional Poisoning death in young children. The US Food and Drug Administration proclaimed a regulation for unit-dose packaging of Iron supplements in 1997. Objective To determine whether the requirement for unit-dose packaging of Iron supplements decreases the incidence of Iron ingestion and the incidence of deaths due to Iron Poisoning in children younger than 6 years. Methods This is a preintervention-postintervention study of the US federally mandated requirement for unit-dose packaging of Iron supplements. The 10 years prior to the intervention were compared with the 5 years after its promulgation. The incidences of Iron ingestion and of Iron Poisoning deaths for children younger than 6 years were obtained from the annual reports of the American Association of Poison Control Centers (Washington, DC). Results The average number of Iron ingestion calls per 1000 of all calls to poison control centers regarding children younger than 6 years decreased from 2.99 per 1000 to 1.91 per 1000 (odds ratio, 1.29 [95% confidence interval, 1.27-1.32]; P P  = .03). Conclusions These are the first data that show a decrease in the incidence of nonintentional ingestion of a specific drug by young children and a decrease in mortality from Poisoning by this drug after the introduction of unit-dose packaging. There was a decrease in the incidence of Iron ingestion and a dramatic decrease in the number of deaths due to Iron Poisoning. This validates unit-dose packaging as an effective strategy for the prevention of Iron Poisoning and Iron Poisoning deaths in young children. This highly effective intervention should be considered for other medications with a high hazard for morbidity and mortality when taken as an overdose.

  • unit dose packaging of Iron supplements and reduction of Iron Poisoning in young children
    JAMA Pediatrics, 2005
    Co-Authors: Milton Tenenbein
    Abstract:

    BACKGROUND: Iron Poisoning is a major cause of unintentional Poisoning death in young children. The US Food and Drug Administration proclaimed a regulation for unit-dose packaging of Iron supplements in 1997. OBJECTIVE: To determine whether the requirement for unit-dose packaging of Iron supplements decreases the incidence of Iron ingestion and the incidence of deaths due to Iron Poisoning in children younger than 6 years. METHODS: This is a preintervention-postintervention study of the US federally mandated requirement for unit-dose packaging of Iron supplements. The 10 years prior to the intervention were compared with the 5 years after its promulgation. The incidences of Iron ingestion and of Iron Poisoning deaths for children younger than 6 years were obtained from the annual reports of the American Association of Poison Control Centers (Washington, DC). RESULTS: The average number of Iron ingestion calls per 1000 of all calls to poison control centers regarding children younger than 6 years decreased from 2.99 per 1000 to 1.91 per 1000 (odds ratio, 1.29 [95% confidence interval, 1.27-1.32]; P<.001). The number of deaths decreased from 29 to 1 (odds ratio, 13.56 [95% confidence interval, 1.85-99.52]; P = .03). CONCLUSIONS: These are the first data that show a decrease in the incidence of nonintentional ingestion of a specific drug by young children and a decrease in mortality from Poisoning by this drug after the introduction of unit-dose packaging. There was a decrease in the incidence of Iron ingestion and a dramatic decrease in the number of deaths due to Iron Poisoning. This validates unit-dose packaging as an effective strategy for the prevention of Iron Poisoning and Iron Poisoning deaths in young children. This highly effective intervention should be considered for other medications with a high hazard for morbidity and mortality when taken as an overdose.

  • Iron Poisoning in young children association with the birth of a sibling
    Canadian Medical Association Journal, 2003
    Co-Authors: David N Juurlink, Milton Tenenbein, Gideon Koren, Donald A Redelmeier
    Abstract:

    Background: Iron is a leading cause of death due to Poisoning in young children. Because perinatal Iron therapy is common, the presence of these tablets, which have a candylike appearence, in the home may pose a hazard to a mother9s other young children. We explored the association between Iron Poisoning in young children and the birth of a sibling. Methods: We conducted a population-based case-control study linking health care databases in Ontario. Health care records for the mothers of children less than 3 years of age admitted to hospital with Iron Poisoning between Apr. 1, 1991, and Mar. 31, 2000, were compared with those for the mothers of age- and sex-matched control children without Iron Poisoning. Results: We studied records for 40 children admitted to hospital for Iron Poisoning. Seventeen cases (42%) occurred within a year (before or after) a sibling9s birth. Children whose mothers had given birth to a sibling were almost twice as likely as children whose mothers had not given birth to a sibling to be admitted for Iron Poisoning within 6 months of birth (adjusted odds ratio [OR] 1.9, 95% confidence interval [CI] 0.9 to 3.9). The postpartum year was associated with a consistently elevated risk, including an almost 4-fold increase in the risk of Iron Poisoning during the first postpartum month (adjusted OR 3.6, 95% CI 0.8 to 16.5). Interpretation: Pregnancy is a major risk factor for Iron Poisoning in young children, and the period immediately after delivery is associated with the greatest risk. Almost half of all hospital admissions for Iron Poisoning in young children could be prevented by keeping Iron supplements safely out of reach in the year before and after the birth of a sibling.

  • hepatotoxicity in acute Iron Poisoning
    Clinical Toxicology, 2001
    Co-Authors: Milton Tenenbein
    Abstract:

    Although hepatotoxicity is a known sequela of acute Iron Poisoning, the literature describing it is confined to sporadic reports. Key issues such as prognosis and whether this is a dose-related phenomenon are not addressed. Review of this literature and of experimental animal studies demonstrates that it occurs early in the clinical course and has a relatively high mortality. The lowest acute serum Iron concentration associated with hepatotoxicity was 1700 microg/dL (304 micromol/L). Since this greatly exceeds the reference range of 50-150 microg/dL (9-27 micromol/L), it supports a dose-related etiology. Unlike most other hepatotoxins, the periportal areas of the hepatic lobule are the primary sites of injury. As this is the principle sitefor hepatic regeneration, this accountsfor the relatively high mortality rate. An understanding of the pathogenesis of the hepatotoxicity of acute Iron Poisoning is central to the identification of rational and effective interventions. From the clinical perspective, the relatively high mortality rate of Iron Poisoning-induced hepatotoxicity requires vigilance for its onset and earlier consideration of liver transplantation.

  • benefits of parenteral deferoxamine for acute Iron Poisoning
    Clinical Toxicology, 1996
    Co-Authors: Milton Tenenbein
    Abstract:

    AbstractObjective: To review the benefits of deferoxamine for the treatment of Iron Poisoning. Methods: Both the basic science and clinical literature on deferoxamine were reviewed by comprehensive computer literature search. This was supplemented by references identified from bibliographies of pertinent articles and books. Results: The basic science literature supports deferoxamine as an attractive antidote for Iron Poisoning. There were no dose response studies in the human or animal literature. There were no randomized controlled trials or case controlled studies of patients with toxicity (serum Iron concentration > 500 μg/dL). All data were descriptive and anecdotal. Therefore fundamental parameters such as indications for administration, dose, route and duration of therapy are unclear and efficacy is unproven. Conclusion: Deferoxamine is attractivefor the treatment of Iron Poisoning despite the lack of knowledge for its optimal use and remains the drug of choice for the treatment of significant Iron ...

Joseph A Zenel - One of the best experts on this subject based on the ideXlab platform.

Randall W. Yatscoff - One of the best experts on this subject based on the ideXlab platform.

  • The total Iron-binding capacity in Iron Poisoning. Is it useful?
    JAMA Pediatrics, 1991
    Co-Authors: Milton Tenenbein, Randall W. Yatscoff
    Abstract:

    • Traditionally, a serum Iron concentration in excess of the total Iron-binding capacity (TIBC) is considered as an indication for deferoxamine therapy in acute Iron Poisoning. We observed a reversible elevation of the TIBC in patients with Iron Poisoning that coincided with their acute hyperferremia and have hypothesized that this is a laboratory aberration. We tested this hypothesis in vitro and found that the addition of Iron to test serum samples produced a related increase in the TIBC, and alteration of the assay by providing additional adsorbent prevented this occurrence. We also evaluated the reproducibility of the TIBC as performed by 500 laboratories on 10 different reference samples. The mean coefficient of variation was 16%, which was unsatisfactory. We concluded that the TIBC should not be used in the decision for the initiation of deferoxamine therapy in acute Iron Poisoning. Furthermore, high TIBC values that are occasionally seen in patients with Iron Poisoning should not be considered as providing a protective effect. (AJDC. 1991;145:437-439)

  • Gastrotomy and whole bowel irrigation in Iron Poisoning.
    Pediatric emergency care, 1991
    Co-Authors: Milton Tenenbein, Nathan E. Wiseman, Randall W. Yatscoff
    Abstract:

    Ipecac and gastric lavage are questionable interventions for the overdose patient, and activated charcoal does not absorb Iron. Gastrotomy and whole bowel irrigation have been described as unique interventions for this Poisoning. We describe a patient who was treated with each of these. Because less than half of the Iron was removed during surgery, and because the chelation requirement was modest, it is likely that whole bowel irrigation removed a significant amount of Iron. We believe that this combined approach contributed to our patient's positive outcome.

Judy Black - One of the best experts on this subject based on the ideXlab platform.

Anthony J Tomassoni - One of the best experts on this subject based on the ideXlab platform.

  • usefulness of the total Iron binding capacity in the evaluation and treatment of acute Iron overdose
    Annals of Emergency Medicine, 1999
    Co-Authors: Jonathan E Siff, Stephen W Meldon, Anthony J Tomassoni
    Abstract:

    The ingestion of Iron-containing products is a potential toxicologic emergency. The total Iron binding capacity (TIBC) has been used widely as a predictor of end-organ toxicity and a guide to the need for deferoxamine therapy. When the TIBC is greater than the serum Iron concentration (SIC), it is held that no free Iron is present to cause toxicity. The TIBC fails as a marker of toxicity for several reasons. First, the laboratory methods used to measure TIBC are inaccurate in the setting of Iron overload. Second, the presence of deferoxamine, the antidote for Iron Poisoning, has been shown to make the TIBC measurement inaccurate. Third, TIBC measurements have been shown to be variable. Finally, studies and case reports demonstrate toxicity even when the TIBC is greater than the SIC. These shortcomings of the TIBC invalidate it as a predictor of toxicity in Iron Poisoning.

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